Resilience and psychosocial factors in adult with epilepsy: A longitudinal study.

PURPOSE: Resilience is conceptually characterized as a dynamic process encompassing positive adaptation in the context of significant adversity. Our goal was to assess the resilience in people with epilepsy (PWE) and how it impacts longitudinally on psychosocial factors, with a particular focus on the manifestation of stigmatization-related feelings. METHODS: We consecutively enrolled 78 adults PWE (42.5 ± 16.2 years old); among them 36 (46.1 %) were seizure-free. All subjects completed at baseline (T0) the Resilience Scale (RS-14) and questionnaires for the assessment of depressive symptoms, anxiety and quality of life: respectively, Beck Depression Inventory-II (BD-II), Generalized Anxiety Disorder-7 (GAD-7) and QOLIE-31 (Q31). All patients were followed up prospectively and re-evaluated after 6-22 months (T1; mean: 14 ± 8 months; median 14 months); at follow up they also completed the Stigma Scale of Epilepsy (SSE) for the assessment of the stigma associated with epilepsy. We correlated resilience values with all psychosocial scores at T0 and T1. Factors associated with resilient and vulnerable outcomes were identified. Finally, a multiple stepwise regression analysis was applied to identify predictors for resilience and stigma perception. RESULTS: The results showed for the RS-14 score a significant direct correlation with the Q31 (p < 0.001) and an inverse correlation with the depressive and anxiety symptoms at both times (T0 and T1), as evaluated with BDI-II (p < 0.001) and GAD-7 (p < 0.001). Finally, we found a significant inverse correlation between RS-14 at T0 and the levels of stigmatization assessed with SSE at T1 (p =.015). Using a multiple stepwise regression analysis separately for resilience and stigma perception, depressive symptoms turned out as the best predictors for both variables. Finally, considering longitudinal evaluation we did not observe significant changes in depressive and anxious symptoms, despite a significant reduction in the total number of seizures at follow up. CONCLUSIONS: Our study showed that depressive symptoms, anxiety and quality of life were significantly associated with resilience in PwE. Finally, as a novel finding resilience was proved to affect the perception of stigma related to epilepsy more than seizures.

A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial.

BACKGROUND: Effective smoking cessation programs exist but are underutilized by smokers, especially by disadvantaged smokers. Cessation interventions in dental settings have been shown to be effective, but are not consistently delivered due to provider burden and lack of training, especially on how to counsel smokers who are not motivated to quit. METHODS: This study is a 2-arm, phase III longitudinal randomized controlled efficacy trial to motivate utilization of evidenced based treatments (EBTs) for smoking cessation (e.g., state quitline, clinic-based counseling, the National Cancer Institute's text message program, and pharmacotherapy). Patients attending an urban dental clinic (n = 376) will be randomized to an intervention group (INT; smoking cessation induction video delivered via VR headset during their teeth cleaning, brochure about EBTs, and a 4-week text message program) or control group (CTRL; relaxation video delivered via VR headset during teeth cleaning, the same brochure as INT, and assessment-only text messages). Assessments will occur at baseline, immediately after the clinic appointment, one-month post-appointment and 3-and 6 months later. We hypothesize INT will be more likely to contact EBTs vs CTRL and have greater utilization rates of EBTs. Secondary objectives are to test the efficacy of INT on point-prevalence smoking abstinence, quit smoking attempts, and motivation to quit vs. CTRL. DISCUSSION: Incorporating smoking cessation into a dental clinic visit and targeting all smokers, regardless of motivation to quit, provides proactive reach to cigarette smokers who otherwise may not seek treatment for smoking. TRIAL REGISTRATION: NCT04524533 Registered August 24, 2020.

Survey of Dental Researchers' Perceptions of Sexual Harassment at AADR Conferences: 2015 to 2018.

The American Association for Dental Research (AADR) is committed to providing a collegial, safe, and welcoming environment for all. As part of this effort, we assessed perceptions and experiences related to sexual, gender-based, and non-gender-based harassment among registrants at AADR annual meetings from 2015 to 2018 (n = 10,495); examined demographic factors associated with reported experiences; and identified facilitators and potential solutions concerning these types of harassment. Registrants were emailed an invitation to an anonymous online survey. Demographics were assessed categorically, and response distributions to close-ended survey items were evaluated by these variables. Bivariate analyses of participant demographics were conducted with 8 types of perceived harassment. To determine the demographic distribution of reporters, along with bivariate associations among them, restricted analyses were performed among individuals reporting any type of harassment. Qualitative data analysts conducted content analysis of the open-ended responses to questions asking participants to reflect on the topic. Peer debriefing was used to refine the coding schema. A total of 824 responses were received, of which 172 individuals reported experiencing ≥1 of the 8 types of harassment surveyed. Among those, reports of condescending remarks occurred most frequently (70%). Reported harassment of a more sexual nature was less common by comparison. Reporters of harassment were more likely to be women, members of the AADR/CADR (Canadian Association for Dental Research) divisions, and/or frequent meeting attendees. A total of 229 respondents answered at least 1 of the open-ended questions. While the majority of survey respondents reported no personal experience with harassment at AADR meetings, the fact that 1 in 5 did should be cause for concern. In 2018, AADR introduced a "Professional Conduct at Meetings Policy" delineating unacceptable behaviors, including intimidating or harassing speech and actions. Results of this survey form an important baseline from which its impact may be monitored to ensure that future AADR meetings are respectful, supportive, and safe environments for all.

An unusual cause of dementia: essential diagnostic elements of corticobasal degeneration-a case report and review of the literature.

Corticobasal degeneration (CBD) is an uncommon, sporadic, neurodegenerative disorder of mid- to late-adult life. We describe a further example of the pathologic heterogeneity of this condition. A 71-year-old woman initially presented dysarthria, clumsiness, progressive asymmetric bradykinesia, and rigidity in left arm. Rigidity gradually involved ipsilateral leg; postural instability with falls, blepharospasm, and dysphagia subsequently developed. She has been previously diagnosed as unresponsive Parkinson's Disease. At our clinical examination, she presented left upper-arm-fixed-dystonia, spasticity in left lower limb and pyramidal signs (Babinski and Hoffmann). Brain MRI showed asymmetric cortical atrophy in the right frontotemporal cortex. Neuropsychological examination showed an impairment in visuospatial functioning, frontal-executive dysfunction, and hemineglect. This case demonstrates that association of asymmetrical focal cortical and subcortical features remains the clinical hallmark of this condition. There are no absolute markers for the clinical diagnosis that is complicated by the variability of presentation involving also cognitive symptoms that are reviewed in the paper. Despite the difficulty of diagnosing CBD, somatosensory evoked potentials, motor evoked potentials, long latency reflexes, and correlations between results on electroencephalography (EEG) and electromyography (EMG) provide further support for a CBD diagnosis. These techniques are also used to identify neurophysiological correlates of the neurological signs of the disease.

[Alzheimer's disease: factors affecting caregivers' workload]. / La malattia di Alzheimer: fattori che influenzano il carico di lavoro nel caregiver.

The aim of this study was to investigate which factors could play a role on the work-load of the Alzheimer patients' caregivers. The work-load was measured by means of Zarit's scale and inserted as dependent variable in a regression model, where the following independent variables were considered: education and MMSE of patients, age, sex of both patients and caregivers. The relevant factors resulted patient's age and MMSE, being significantly (p < 0.05) inversely associated with work-load. This score reached his maximum when patient's MMSE ranged between 14 and 16 (medium impairment). However, a large variability was found in this interval, suggesting a possible effect of other factors. In addition, we observed a decrement of work-load when patients were older, being higher at 50 and lower after 72. This effect might be explained by the significant change (especially in terms of social and familial life) due to the illness when the patient is relatively young. When the patient is older, Alzheimer' disease had smaller effect on the caregiver's work-load.

Relationship of blood transfusion, post-operative infections and immunoreactivity in patients undergoing surgery for gastrointestinal cancer.

BACKGROUND AND OBJECTIVE: The immunosuppression induced by perioperative blood transfusion (BT) and its effect on the incidence of post-surgical infectious complications remains controversial. In this study, the relationship between BT and postoperative infections was investigated in 136 gastrointestinal cancer patients submitted to curative surgery. METHODS: Clinical and laboratory variables, data on postoperative infections, infection risk factors and types of transfusion were analyzed. Immune function was evaluated in 76 patients and compared before and after surgery. RESULTS: The overall postoperative infection rate was 28% for the transfused and 4.6% for the untransfused patients. The univariate analysis of investigated variables indicated that BT, progressive cancer stage, duration of surgery, drains, all had significant association with infection. The multiple logistic regression analysis confirmed BT (p = 0.0028) and advanced cancer stage (p < 0.001) as significant risk factors for the postoperative infections. The results of immunological tests showed no significant differences between transfused and untransfused patient groups, after surgery. Comparing pre- and postoperative data from individual patients, an impairment of natural killer (NK) activity was observed in all patients regardless of their transfusional status; the synthesis of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) was also decreased respectively in the untransfused and in the transfused patients. INTERPRETATION AND CONCLUSIONS: These results indicate that other factors, beside BT, can induce immunosuppressive effects in these patients and thus increase their susceptibility to postoperative infections.

Immunoresponsiveness of cancer patients: effect of blood transfusion and immune reactivity of tumor infiltrating lymphocytes.

The immunoreactivity of cancer patients submitted to surgery and perioperatively transfused was investigated. Peripheral blood mononuclear cells (PBMC) and tumor infiltrating lymphocytes (TIL) were tested for the natural killer (NK) cytotoxic activity, for the in vitro synthesis of interleukin-2 (IL-2), interferon-gamma (IFN-gamma), tumor necrosis factor-alpha (TNF-alpha) and prostaglandin E2 (PGE2). The serum levels and the production of PGE2 by PBMC were significantly higher in patients than in controls, whereas no significant differences in the tested immunological variables emerged between the two groups of subjects. Instead, TIL produced significant larger amounts of spontaneous PGE2 (p < 0.001) and significant lower amounts of IFN-gamma (p < 0.001) and TNF-alpha (p < 0.001) than autologous PBMC, suggesting an involvement of PGE2 in the impairment of the host immunoreactivity at the tumor site. To evaluate the immunomodulating effect of blood transfusion, the patients were reexamined 8 to 20 days after surgery. No differences were found in the NK cytotoxic activity, lymphokine synthesis, serum levels, and production of PGE2 between transfused and untransfused patients. These results do not support the hypothesis that blood transfusions negatively affect the immune response of neoplastic patients.

[Analysis of growth, phenotype and cytotoxic activity of tumor infiltrating lymphocytes expanded in vitro with interleukin-2 and interleukin-4: preliminary results]. / Analisi della crescita, del fenotipo e dell'attività citotossica dei linfociti infiltranti i tumori espansi in vitro con interleuchina 2 ed interleuchina 4: risultati preliminari.

Tumor infiltrating lymphocytes (TIL) play an important role in the host immune response to cancer. When these cells are reinfused into cancer patients after in vitro expansion with lymphokines such as interleukin 2 (rIL-2), they often induce regression of tumor metastases. We obtained TIL of enzymatic digestion of 7 human solid tumors and then cultured them with rIL-2 and interleukin 4 (IL-4) at different concentrations for about 36 days. Immunophenotypic analysis was performed at the end of the second and fourth week; cytotoxic activity against autologous and heterologous targets was assessed on the 30th day of culture. The best lymphocytic growth was observed when we used rIL-2 and IL-4 for the first two weeks of culturing and then continued with rIL-2 alone. CD3 and CD56 cells formed the majority of TIL in all cultures. In 4 cases CD4 cells predominated at the initial stage of culturing, with CD8 cells gradually increasing and finally inverting the CD4/CD8 ratio. Autologous cytotoxicity (3/4 cases) appeared to be better in those patients in whom the CD4/CD8 ratio was inverted. These data enable identification of the combination of lymphokines that will will best provide expansion of live TIL active against tumoral cells. This procedure must be followed before in vivo reinfusion of expanded lymphocytes is carried out.

Effects of blood transfusion on the immune responsiveness and survival of cancer patients: a prospective study.

To evaluate whether blood transfusion exerts an adverse influence on cancer evolution, a prospective clinical and immunologic investigation was carried out on 58 surgical patients with gastric or colorectal adenocarcinoma. None had had previous transfusion; 35 received perioperative transfusion. Among preoperative variables, only red cell count and hemoglobin concentration were significantly reduced in the patients transfused at operation. Other clinical characteristics and immunologic functions (except interferon-gamma release) did not differ significantly from those of untransfused patients. The survival rate of transfused patients, although shorter, was not significantly different from that of untransfused patients. Immunologic tests done after surgery on 30 patients (17 transfused and 13 untransfused) did not show significant differences in the two groups. Significant increases in interleukin-2-stimulated production and immunoglobulin M synthesis were observed in transfused patients after surgery. Patients transfused perioperatively with more than 3 units of blood had some evidence of decreased immune function, but differences were not significant. While shorter survival and some immunologic changes may correlate with the number of transfusions, more patients must be studied to determine whether this relationship will be confirmed.

Investigation on the humoral immune response in patients with gastro-intestinal cancer.

The humoral immune reactivity was studied in patients affected by gastro-intestinal cancer. The number of peripheral B lymphocytes, the concentration of serum immunoglobulins (Ig) and of C3 complement factor and the frequency of circulating immuno complexes (CIC) did not significantly differ between patients and age-matched controls, while the C4 factor level was significantly increased. The frequency of serum monoclonal components (M-components) was higher in the patients than in the elderly subjects. Moreover the results concerning the "in vitro" functional response of patient B lymphocytes showed a significant decrease of the proliferative responses to Staphylococcus Aureus Cowan I (SAC) and a significant increase of the IgG and IgM synthesis by peripheral blood mononuclear cells (PBMC) in unstimulated and pokeweed mitogen (PWM) stimulated cultures. The meaning of these results, taken together with those reported by others, is discussed.

Functional analysis of lymphocytes from two patients affected by common variable immunodeficiency (CVI).

Two patients affected by severe hypogammaglobulinemia classified as CVI were studied. Both patients showed an increase in peripheral T cells and a normal or elevated number of surface immunoglobulin-bearing cells (sIg+); the T cell subsets showed a decrease of CD4 and an increment of CD8 cells with an inversion of the CD4/CD8 ratio. Patient peripheral blood mononuclear cells (PBMC) did not proliferate after Staphylococcus aureus Cowan I (SAC) activation. Moreover, patient PBMC were not able to differentiate into plaque - forming cells (PFC) either spontaneously or after pokeweed mitogen (PWM) stimulation. The immunoglobulin synthesis from patient PBMC stimulated in vitro by PWM was very little as compared to controls. When isolated patient B cells were cultured in the presence of exogenous B cell growth factor (BCGF) and BCGF plus anti-mu and anti-delta antibodies, no proliferation was observed. Taken together the results concerning B cell function of our CVI patients indicate the presence of an intrinsic defect of B cells. These cells are normal in number, but they are not able to leave the resting state, enter the activation state, proliferate and differentiate into Ig secreting cells. Moreover the alteration of the T cell subset proportions seems to suggest an impaired cooperation between B and T cells.

Effects of the allogeneic stimulation on B cell function in thalassaemic polytransfused patients.

The immunological abnormalities of polytransfused patients affected by beta-thalassaemia major have been investigated in relation to B cell function. The spontaneous in vitro production of Ig by patient peripheral mononuclear cells was not modified, while the pokeweed mitogen induced IgM synthesis was significantly reduced. However, by comparing the splenectomized and non-splenectomized patients, this alteration proved to be present only in the splenectomized group. The proliferation of patient peripheral B cells in vitro stimulated with B cell growth factor alone was not significantly enhanced in respect to the controls. These results indicate that in vivo activation state of patient B cells is not different from that of the controls. The stimulation of peripheral B cell with anti-mu or anti-alpha antibodies and anti-mu and anti-alpha antibodies plus B cells growth factor induced a significant increase in proliferative responses of B cells from the splenectomized patients. Taken together, these findings suggest that circulating B cells of thalassaemic polytransfused patients are not hyperactivated. The splenectomy can account for the immunological changes observed in our thalassaemic sample as compared to control group.

Immunoenzymatic determination of immunoglobulins secreted by human peripheral blood lymphocytes in pokeweed mitogen and lipo-polysaccharide stimulated cultures.

Immunoglobulins (Ig) production by peripheral blood mononuclear cells (PBMC) from 27 healthy subjects at the 6th and 12th day of in vitro stimulation by pokeweed mitogen (PWM) or bacterial lipo-polysaccharide (LPS) was investigated. Total IgG, IgA, IgM in the culture supernatants were measured by an enzyme linked immunosorbent assay (ELISA). The average values of Ig production (in ng per ml of culture supernatants) under PWM and LPS stimulation after 12 days of culture are respectively: 3397 and 2557 for IgG, 512 and 374 for IgA, 3172 and 1439 for IgM. The use of PWM and LPS mitogens for stimulating Ig secreting cells may provide insights into the nature of the interacting cells on immune responses and into the pathogenesis of different diseases.

Immune profile alterations in thalassaemic patients.

Aspects of the humoral and cellular immune response have been studied in polytransfused patients with beta-thalassaemia major. Serum immunoglobulins (G, A, M) levels were significantly higher than in controls; reduced C4 serum level and high incidence of circulating immune complexes and anti-nuclear autoantibodies were found in the majority of patients. Marked increases were also observed in absolute and relative numbers of lymphocytes and their subpopulations. Such results suggested that the allogenic stimulation, by frequent transfusion, is the mainly responsible of the immunological alterations observed in these patients.

[Detection of circulating immune complexes with the polyethylene glycol precipitation test: advantages and limitations of the method]. / Ricerca degli immunocomplessi circolanti mediante il test di precipitazione con glicole polietilenico (PEG): vantaggi e limiti del metodo.

The precipitation test with 3.5% PEG has been used to reveal the presence of circulating immuno complexes (IC) in a sample of 130 blood donors. The asymmetry in the O.D. distribution has been corrected by the square root transformation. The positivity threshold has been fixed at the superior extreme of the 95% fiducial interval relative to the transformed data of the control sample, namely at 0.125 O.D.280nm. The correlation between O.D. values obtained with PEG-test and serum concentration of IgG, IgA, IgM, C3 has been studied in 50 of 130 blood donors, 53 patients with gastro-intestinal neoplasm, 73 patients with different forms of the rheumatic disease and 17 patients with cryoglobulinaemia. No significant correlation has been found in normal subjects. Instead, a positive correlation could be demonstrated between O.D. values and IgG concentration both in neoplastic, rheumatic and cryoglobulinemic patients, between O.D. values and IgM concentration in rheumatic patients only; a negative correlation has been found in rheumatic patients with regard to C4. The analytical results are, finally, discusses in relation to the reliability of the method as routine test for the detection of circulating IC.

[Changes in serum immunoglobulin levels in aged subjects]. / Variazioni dei livelli delle immunoglobuline sieriche in soggetti anziani.

Serum immunoglobulin G, A, M levels have been determined on serum samples from 97 healthy elder subjects aged from 60 to 92. No qualitative changes were detected by electrophoretic analysis. The results show a significative increase with age in IgG and IgA concentrations; the IgM concentration results unaffected.

IgG, IgA and IgM concentration in human sera from different age groups: statistical evaluation.

A statistical analysis is presented of the results obtained from the measure of the serum concentration of IgG, A, M in 773 blood donors. In each of the two groups identified by sex, four subgroups were established according to age in ten years intervals from 20 to 59. On the basis of the results of the analysis, different fiducial intervals of normal values (calculated as mean +/- 2 X standard deviation) have been proposed. 1) A unique interval for IgG: 87-234 U.I. 2) Two intervals for IgA: 54-236 U.I. for subjects under 40 years and 64-270 U.I. for subjects over 40 years. 3) Four intervals for IgM: one for males under 40 years: 65-364 U.I., one for males over 40 years: 57-314 U.I., one for females under 50 years: 47-363 U.I., and one for females over 50 years: 53-434 U.I.